The world of ‘Call the Midwife’ is the starting point for the introduction of patient shielding, particularly
gonad shielding. What we know now and the abilities of our modern equipment is compared and contrasted to 1957.
Finally the potential dangers of combining the old and new are highlighted.

Educational aims:
• To be able to summarise the historical and current application of patient shields used in diagnostic
radiography.
• To learn how to compare the utility of patient shields with other optimisation interventions.
• To identify and avoid potential adverse outcomes due to shield use in diagnostic radiography.

References:
• Abram E, Wilkinson DM, Hodson CJ. Gonadal protection from X radiation for the female. Br J Radiol.
1958;31:335–336. doi: 10.1259/0007-1285-31-366-335. [PubMed] [Cross Ref]
• Almén A, Mattsson S (1995) The radiation dose to children from X-ray examinations of the pelvis and the urinary
tract. Br J Radiol 68: 604-613. [Crossref]
• Ardran GM, Kemp FH. Protection of the male gonads in diagnostic procedures. Br J Radiol. 1957;30:280. doi:
10.1259/0007-1285-30-353-280. [PubMed] [Cross Ref]
• Bardo DM, Black M, Schenk K, Zaritzky MF (2009) Location of the ovaries in girls from newborn to 18 years of
age: reconsidering ovarian shielding. Pediatr Radiol 39:253-259. [Crossref]
• Cook JV, Kyriou JC, Pettet A, Fitzgerald MC, Shah K, et al. (2001) Key factors in the optimization of
paediatric X-ray practice. Br J Radiol 74: 1032-1040. [Crossref]
• Doolan A, Brennan PC, Rainford LA, Healy J (2004) Gonad protection for the antero-posterior projection of the
pelvis in diagnostic radiography in Dublin hospitals. Radiography 10: 15-21.
• FDA (2013) 21 CFR 1000.50 Recommendation for the use of specific area gonad shielding on patients during
medical diagnostic x-ray procedures. Available via http://cfr.vlex.com/vid/1000-recommendation-gonad-
shielding-patients-ray-19716085, 1976. Accessed
• Frantzen, M. J., Robben, S., Postma, A. A., Zoetelief, J., Wildberger, J. E., & Kemerink, G. J. (2012). Gonad
shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights into Imaging, 3(1),
23–32. http://doi.org/10.1007/s13244-011-0130-3
• Gul A, Zafar M, Maffulli N (2005) Gonadal shields in pelvic radiographs in pediatric patients. Bull Hosp Jt Dis
63: 13-14. [Crossref]
• Hamada, N., & Fujimichi, Y. (2014). Classification of radiation effects for dose limitation purposes: history,
current situation and future prospects. Journal of Radiation Research, 55(4), 629–640.
http://doi.org/10.1093/jrr/rru019
• Hayre, CM. Blackman, S. and Eyden, A. (2018) Attitudes and perceptions of radiographers applying lead (Pb)
protection in general radiography: An ethnographic study Radiography , Volume 24 , Issue 1 , e13 - e18
https://doi.org/10.1016/j.radi.2017.07.010
• Health and Safety Executive. (2006) Guidance note PM77. Equipment used in connection with medical exposure. 3rd
edn. www.hse.gov.uk/pubns/guidance/pm77.pdf.
• Kenny N, Hill J (1992) Gonad protection in young orthopaedic patients. BMJ 304: 1411-1413. [Crossref]
• Kotre CJ, & Walker A Duty of candour and the definition of moderate harm for radiation overexposure and
exposures much greater than intended in diagnostic radiology The British Journal of Radiology Vol 87 p1034
• Little MP, Goodhead DT, Bridges BA, et al. Evidence relevant to untargeted and transgenerational effects in the
offspring of irradiated parents, Mutat Res , 2013, vol. 753 (pg. 50-67)
• Lorenz W. Physical and technical problems of radiation protection in medical installations. Fortschr Geb
Rontgenstr Nuklearmed. 1958;88:251–276. doi: 10.1055/s-0029-1226032. [PubMed] [Cross Ref]
• MacKay M, Hancy, C, Crowe A, D’Rozario, R, Ng CKC (2012) Attitudes of Medical Imaging Technologists on Use of
Gonad Shielding in General Radiography.The Radiographer 59: 35-39.
• Meggitt G (2008) Taming the rays – a history of radiation and protection. Raleigh, Lulu.com
• Miller RW. Some potential hazards of the use of roentgen rays in pediatrics. Pediatrics. 1953;11:294–303.
[PubMed]
• National Radiological Protection Board. National protocol for patient dose measurements in diagnostic
radiology. Report of the Working Party of the Institute of Physical Science in Medicine (Chilton, Didcot, UK:
NRPB) (1992).
• Sikand M, Stinchcombe S, Livesley PJ (2003) Study on the use of gonadal protection shields during paediatric
pelvic X-rays. Ann R Coll Surg Engl 85: 422-425. [Crossref]
16
• Sikand M, Stinchcombe S, Livesley PJ (2003) Study on the use of gonadal protection shields during paediatric
pelvic X-rays. Ann R Coll Surg Engl 85: 422-425. [Crossref]
• Tatsukawa Y, Cologne JB, Hsu WL, et al. Radiation risk of individual multifactorial diseases in offspring of
the atomic-bomb survivors: a clinical health study, J Radiol Prot , 2013, vol. 33 (pg. 281-93)
• Teferi, S. Tequabo, Y. and Bedane, D. (2014) Preliminary Study on the practice of gonad shielding during pelvic
radiography Radilogical Diagnostic Imaging Vol1 DOI:10.15761/RDI.1000105
• Wainwright AM (2000) Shielding reproductive organs of orthopaedic patients during pelvic radiography. Ann R
Coll Surg Engl 82: 318-321
• Warlow, T, Walker-Birch, P, Cosson, P. (2014) Gonad shielding in paediatric pelvic radiography: Effectiveness
and practice. Radiography, Aug2014; 20(3): 178-182. 5p.
• Whitehead G, Griffiths JT. (1961) The Leicester gonad protector: a device to afford localised protection from
diagnostic x-irradiation. Br J Radiol. 1961;34:135–136. doi: 10.1259/0007-1285-34-398-135. [PubMed] [Cross Ref]
Further reading:
Warlow T., Walker-Birch, P., and Cosson, P. (2014) Gonad shielding in paediatric pelvic radiography:
effectiveness and practice. Radiography. DOI: http://dx.doi.org/10.1016/j.radi.2014.01.002

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